OUTCOMES WITH AMBULATORY ANESTHESIA DELIVERED IN AN ORAL AND MAXILLOFACIAL SURGERY TRAINING PROGRAM

Purpose: To determine the complication rate associated with IV sedation in an oral and maxillofacial surgery residency training program. Materials and methods: This is a prospective cohort study which enrolled patients who would receive IV sedation for oral surgery procedures in the clinic setting of an OMFS residency training program. Trainees chose their own anesthetic technique, and recorded demographic data, anesthetics used and dose, and any intraoperative or postoperative complications. Demographic and medication data were used as predictor variables. Outcome variables included any reported complication. Fisher’s exact test was used to compare complication rate by subgroups. Results: 1,005 patients were treated over an 18-month period. The overall complication rate was 2.29%. The most common complication was post-operative nausea (n=11, 1.09%). Other complications included: emesis (n=1), laryngospasm (n=1), prolonged recovery (n=3), failed sedation due to agitation (n=1), intra-operative hypertension (n=1), post-operative hypertension (n=1), ST elevation (n=1), IV infiltration (n=2), syncope during IV access (n=1), and respiratory depression (n=2). There were no deaths or adverse events requiring escalation of level of care. Ketamine use had a higher rate of post-operative nausea (1.21%). Propofol was associated with lower rate of post-operative nausea (0.68%). Males had a higher rate of complications than females overall (2.4% vs. 2.2%), but females had a higher rate of post-operative nausea and vomiting (0.96% vs. 1.19%). Average length of procedure was greater in the group that experienced complications vs. those who did not (37.5 vs. 31.6 minutes, respectively). None of these differences were statistically significant. Conclusions: Modern IV sedation anesthesia technique utilized in oral and maxillofacial surgery training programs are safe and the complication rate is low. Post-operative nausea is the most common complication. Ketamine may increase the risk of PONV. Prior history is a good predictor of PONV. Length of procedure may increase the risk of complication

研究目的：明确口腔颌面外科住院医师培训项目中静脉镇静（intravenous sedation, IV sedation）相关并发症发生率。
材料与方法：本研究为前瞻性队列研究，纳入某口腔颌面外科（oral and maxillofacial surgery, OMFS）住院医师培训项目门诊场景下，接受静脉镇静口腔手术的患者。受训医师自行选择麻醉技术，并记录患者人口统计学资料、所用麻醉药物及剂量，以及所有术中、术后并发症。以人口统计学及用药数据作为预测变量，结局变量为任何报告的并发症。采用Fisher确切概率法按亚组比较并发症发生率。
结果：本研究在18个月周期内共收治1005例患者，总体并发症发生率为2.29%。最常见的并发症为术后恶心（n=11，占比1.09%），其余并发症包括：呕吐（n=1）、喉痉挛（n=1）、苏醒延迟（n=3）、因躁动导致镇静失败（n=1）、术中高血压（n=1）、术后高血压（n=1）、ST段抬高（n=1）、静脉渗漏（n=2）、静脉穿刺时晕厥（n=1）及呼吸抑制（n=2）。无死亡或需升级护理级别的不良事件发生。使用氯胺酮的患者术后恶心发生率更高（1.21%），而丙泊酚相关术后恶心发生率更低（0.68%）。整体而言男性并发症发生率高于女性（2.4% vs 2.2%），但女性术后恶心呕吐（postoperative nausea and vomiting, PONV）发生率更高（1.19% vs 0.96%）。发生并发症的患者平均手术时长较未发生并发症者更长（分别为37.5分钟与31.6分钟），但上述差异均无统计学意义。
结论：口腔颌面外科培训项目中应用的现代静脉镇静麻醉技术安全性良好，并发症发生率较低。术后恶心为最常见并发症。氯胺酮可能增加术后恶心呕吐风险。既往病史可较好预测术后恶心呕吐风险。手术时长可能增加并发症发生风险。